title: The impact of previous ureteroscopic tumor ablation on oncologic outcomes after radical nephrouretectomy for upper urinary tract urothelial carcinoma.
abstract: Abstract We investigated whether a history of endoscopic tumor ablation impacts oncologic outcomes after radical nephroureterectomy (RNU) for upper urinary tract urothelial carcinoma (UTUC). Using a multi-institutional database that contained patients who were treated with RNU, oncologic outcomes were assessed according to history of ureteroscopic tumor ablation. Disease-free survival (DFS) and cancer-specific survival (CSS) were estimated using the Kaplan-Meier survival analysis. Multivariate Cox regression analyses were performed to determine independent predictors of disease recurrence and cancer-specific mortality after RNU. The study included 1268 patients, 853 men and 415 women, with a mean age of 67.5 years (range 32-94 y) and 52.8 months median follow-up after RNU. A total of 175 (13%) patients underwent RNU after endoscopic tumor ablation and 1093 (87%) patients underwent RNU without a history of endoscopic ablation. The 5-year DFS and CSS rates were 72% and 77% in those with a history of tumor ablation vs 69% and 73% in those without a history of ablation (P = 0.171 and P = 0.365, respectively). In multivariate Cox regression analysis, history of ablation therapy was not associated with disease recurrence or cancer-specific mortality (hazard ratio [HR]: 0.79, P = 0.185 and HR: 0.7, P = 0.078, respectively). Our collaborative international efforts suggest that in selected patients, endoscopic tumor ablation does not adversely affect the recurrence and survival after subsequent RNU for UTUC. Our data support the continued role of ureteroscopic ablation of UTUC in appropriately selected patients.
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
authors.forename: Cenk
authors.initials: C
authors.lastname: Gurbuz
authors.forename: Ramy F
authors.initials: RF
authors.lastname: Youssef
authors.forename: Shahrokh F
authors.initials: SF
authors.lastname: Shariat
authors.forename: Yair
authors.initials: Y
authors.lastname: Lotan
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Wood
authors.forename: Arthur I
authors.initials: AI
authors.lastname: Sagalowsky
authors.forename: Richard
authors.initials: R
authors.lastname: Zigeuner
authors.forename: Eiji
authors.initials: E
authors.lastname: Kikuchi
authors.forename: Alon
authors.initials: A
authors.lastname: Weizer
authors.forename: Jay D
authors.initials: JD
authors.lastname: Raman
authors.forename: Mesut
authors.initials: M
authors.lastname: Remzi
authors.forename: Marco
authors.initials: M
authors.lastname: Roscigno
authors.forename: Francesco
authors.initials: F
authors.lastname: Montorsi
authors.forename: Christian
authors.initials: C
authors.lastname: Bolenz
authors.forename: Wassim
authors.initials: W
authors.lastname: Kassouf
authors.forename: Vitaly
authors.initials: V
authors.lastname: Margulis
mesh_terms: D055011:Ablation Techniques / Q000379:methods*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D016016:Proportional Hazards Models; D016896:Treatment Outcome; D014513:Ureter / Q000601:surgery*; D018666:Ureteroscopy / Q000379:methods*; D014571:Urologic Neoplasms / Q000601:surgery*; D019459:Urothelium / Q000473:pathology